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J Korean Soc Emerg Med > Volume 27(5); 2016 > Article
Journal of The Korean Society of Emergency Medicine 2016;27(5): 429-435.
의식이 명료한 상태로 내원한 글루포시네이트 중독환자에서 신경학적 합병증 예측인자로서 암모니아 농도 차이의 유용성
오태환1, 이재백1, 진영호1, 정태오1, 조시온1, 김소은1, 이정문2, 윤재철1
1전북대학교병원 응급의학과
2전북대학교병원 외상팀
Difference of Ammonia Level as Predictor of Delayed Neurologic Complication in Patients with Glufosinate Ammonium Herbicide Poisoning Presented with Alert Mentality
Tae Hwan Oh1, Jae Baek Lee1, Young Ho Jin1, Tae Oh Jeong1, Si On Jo1, So Eun Kim1, Jeong Moon Lee2, Jae Chol Yoon1
1Department of Emergency Medicine, Chonbuk National University Hospital, Jeonju, Korea
2Trauma Team, Chonbuk National University Hospital, Jeonju, Korea
Correspondence  Jae Chol Yoon ,Tel: 063-250-2670, Fax: 063-250-1075, Email: jcyoon75@jbnu.ac.kr,
Received: May 26, 2016; Revised: May 31, 2016   Accepted: August 5, 2016.  Published online: October 30, 2016.
The serum ammonia level was postulated as a surrogate marker for severe neurotoxicity in glufosinate ammonium (GLA) poisoning. The aim of this study is to evaluate whether the level of serum ammonia can predict delayed neurologic complications in patients with GLA poisoning presented with alert mentality.
Thirty-six GLA-poisoned patients presented to our emergency department with alert mentality initially were analyzed retrospectively. The baseline characteristics, laboratory findings, ammonia level (initial and second ammonia level, frequency of hyperammonemia, and difference of ammonia level), and clinical outcomes were compared between non-neurologic (n=16) and neurologic complication groups (n=20).
Neurologic complications occurred in 20 patients (55.6%) with 14.3 hours (median) of latent period. The initial ammonia level and frequency of initial hyperammonemia did not show any difference between the two groups. However, the difference of ammonia level between the 2nd and 1st samples was an independent predictor of delayed neurologic complication (adjusted odds ratio; 1.184 (95% confidence interval (CI); 1.01-1.387, p=0.037)). The area under the curve and cut-off point of the difference of ammonia level for the prediction of delayed neurologic complication was 0.936 (95% CI; 0.756-0.992) and 15.4 umol/L respectively.
The difference of ammonia level rather than the initial ammonia level could be used to predict delayed neurologic complication in GLA-poisoned patients presented with alert mentality.
Key words: Ammonia, Glufosinate ammonium, Neurotoxicity
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